A new report conducted by NORC at the University of Chicago on behalf of Better Medicare Alliance’s Center for Innovation in Medicare Advantage (MA) highlights innovative approaches that MA plans are doing to address social determinants of health (SDoH) for beneficiaries. However, researchers acknowledge that barriers remain.
The 27-page report, “Innovative Approaches to Addressing Social Determinants of Health for Medicare Advantage Beneficiaries,” released on Thursday is based on interviews with more than 20 experts from 14 organizations representing health plans, providers, health plan associations, not-for-profit social service organizations, and service and technology vendors.
The findings show a “dramatic increase in plan activity to address social needs” within MA–particularly in the areas of social isolation, transportation, housing, and food–buoyed by recent flexibilities allowing MA plans to offer expanded supplemental benefits for non-primarily health-related services and targeted to the chronically ill. Separate research cited in the report shows that 845 separate MA plans participated in Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2021, compared to 245 the year prior.
NORC’s research also depicts how MA plans and partners collect data on beneficiaries’ social risk factors in the absence of consistent data collection guidelines and standards from the Centers for Medicare & Medicaid Services (CMS), including through investing in artificial intelligence and predictive analytics and incorporating SDoH questions into Health Risk Assessments.
Still, barriers to further SDoH innovations remain. This includes technology limitations, misaligned incentives, and the disconnect between health care systems and social services. The report proposes potential solutions to spur greater investment in SDoH, including:
- Stronger CMS guidance and new standards for collection of SDoH information
- Information sharing between the Department of Health & Human Services (HHS) and state Medicaid agencies on beneficiaries’ eligibility for social support programs
- Encouraging providers to use ICD-10 Z codes to promote the identification of social needs
- Permanently authorizing Value-Based Insurance Design (VBID) authority to promote greater SDoH innovation in Medicare
- Modifying MA risk adjustment and Star Ratings to account for beneficiaries’ social risk factors
“The health care system recognizes the significant impact of unmet social needs on peoples’ health and wellbeing. However, we lack a systematic approach for identifying social needs, paying for interventions to address those needs, and evaluating the outcomes of these programs,” said Caroline Pearson, senior vice president at NORC, in the research announcement. “With policy support, Medicare Advantage plans can play a crucial role in addressing these social determinants of health.”
Kenneth Thorpe, Ph.D., chair of the Better Medicare Alliance Board of Directors and chair of the Department of Health Policy and Management in the Rollins School of Public Health at Emory University, agreed. “As Medicare Advantage enrollment continues to soar–driven by diverse, medically complex, and at-risk beneficiaries it is crucial that it be equipped with the tools to deliver whole-person care to this increasingly vulnerable population,” he said in the announcement. “This report paints an encouraging picture of the significant investments Medicare Advantage plans and partners are already making in this space, with the number of Medicare Advantage plans providing SSBCI increasing more than three-fold in a single year. Sensible policy changes can spur further innovation.”